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Reary JA, Katsavochristou A, Powers JM, Kiat-Amnuay S. Effect of surface pretreatment and artificial aging on the retention of lithium disilicate crowns cemented to zirconia implant abutments. J Prosthet Dent 2024; 131:459-467. [PMID: 35513920 DOI: 10.1016/j.prosdent.2022.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 11/21/2022]
Abstract
STATEMENT OF PROBLEM Recent advancements in restorative dentistry have seen an increase in the use of ceramic restorations and zirconia implant abutments. However, how the pretreatment of a zirconia abutment and different artificial aging protocols affect the bond strength of a cemented, monolithic lithium disilicate crown is unclear. PURPOSE The purpose of this in vitro study was to evaluate the effect of surface pretreatment on the retentive strength of milled lithium disilicate crowns bonded to custom zirconia implant abutments with different resin cements after thermocycling and long-term aging. MATERIAL AND METHODS A total of 144 crowns (n=8) were milled and bonded to 144 abutments. In the experimental groups, 72 abutments were airborne-particle abraded with 50-μm aluminum oxide before bonding. All specimens were stored at 37 °C in 100% humidity for 24 hours. Forty-eight specimens were subjected to thermocycling, and another 48 were subjected to aging for 6 months. Retentive strength was measured by using a pull-off test with a universal testing machine. Retentive strength values were calculated and compared with 3-way analysis of variance and a Tukey-Kramer post hoc test (α=.05). RESULTS In the 24-hour aging group, retention for all experimental groups was significantly higher (P<.05) than for the control group, except for Panavia 21 with Clearfil Ceramic Primer. In the thermocycling and long-term aging groups, all cements in the experimental group displayed significantly higher retention than the control. The airborne-particle abrasion of custom zirconia implant abutments with 50-μm aluminum oxide before bonding to lithium disilicate crowns significantly increased the bond strength of the Multilink Hybrid Abutment with Monobond Plus and RelyX Ultimate with Scotchbond Universal cements after 24-hour aging, but not of Panavia 21 with Clearfil Ceramic Primer. CONCLUSIONS Airborne-particle abrasion significantly increased the bond strength of all 3 cements after thermocycling and long-term aging.
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Affiliation(s)
- Juston A Reary
- Private practice and Former Graduate Prosthodontics Resident, Department of Prosthodontics, Michael E DeBakey Veterans Affairs Medical Center and University of Texas Health Science Center at Houston School of Dentistry, Houston, Texas
| | - Anastasia Katsavochristou
- Assistant Professor, Division of Prosthodontics, University of Kentucky College of Dentistry, Lexington, Kentucky
| | - John M Powers
- Professor Emeritus, Department of Restorative Dentistry and Prosthodontics, University of Texas Health Science Center at Houston School of Dentistry, Houston, Texas
| | - Sudarat Kiat-Amnuay
- Professor, Department of General Practice and Dental Public Health, University of Texas Health Science Center at Houston School of Dentistry, Houston, Texas; Section Head, Houston Center for Biomaterials and Biomimetics, University of Texas Health Science Center at Houston School of Dentistry, Houston, Texas.
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Guo D, Mühlemann S, Pan S, Zhou Y, Jung RE. A double-blind randomized within-subject study to evaluate clinical applicability of four digital workflows for the fabrication of posterior single implant crown. Clin Oral Implants Res 2023; 34:1319-1329. [PMID: 37638493 DOI: 10.1111/clr.14171] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 08/03/2023] [Accepted: 08/13/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE To compare efficiency and clinical efficacy of posterior single implant crowns (PSIC) fabricated using four digital workflows. MATERIALS AND METHODS Twenty-two patients with one missing first molar were included. Each patient received four screw-retained implant crowns fabricated through four different workflows including a fully digital workflow with immediate digital impression (Group i-IOS), a fully digital workflow with digital impression after implant osseointegration (Group d-IOS), a model-based hybrid workflow using immediate analogue impression (Group i-AI), and a model-based hybrid workflow with conventional analogue impression after implant osseointegration (Group d-AI). The crown delivery sequence was randomized and blinded. The efficiency for each workflow and clinical outcome of each crown were recorded. RESULTS The average clinical working time in fully digital workflows (i-IOS 46.90 min, d-IOS 45.66 min) was significantly lower than that in the hybrid workflows (i-AI 54.59 min, d-AI 55.96 min; p < .001). Significantly more laboratory time was spent in hybrid workflows (i-AI 839.60 min, d-AI 811.73 min) as compared to fully digital workflows (i-IOS 606.25 min, d-IOS 607.83 min, p < .01). No significant differences in the chairside time at delivery were found. More crowns in Group i-AI (15%) needed additional laboratory interventions than in the other groups (p = .029). CONCLUSION Digital impression and model-free fully digital workflow improved prosthetic efficiency in the fabrication of PSIC. With the limitation that the results were only applicable to the implant system used and the digital technologies applied, findings suggested that workflows integrating immediate impression with implant surgery procedure was clinically applicable for restoration of PSIC.
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Affiliation(s)
- Danni Guo
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - Sven Mühlemann
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Shaoxia Pan
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - Yongsheng Zhou
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Moura DMD, de Araújo GM, de Araújo LNM, de Vasconcelos Gurgel BC, de Oliveira Dal Piva AM, Ozcan M, de Assunção E Souza RO. Clinical performance of monolithic polymer-infiltrated ceramic and lithium disilicate posterior crowns: A controlled, randomized, and double-blind clinical trial. J Prosthet Dent 2023:S0022-3913(23)00483-3. [PMID: 37690857 DOI: 10.1016/j.prosdent.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 09/12/2023]
Abstract
STATEMENT OF PROBLEM The success rate of monolithic polymer-infiltrated ceramic posterior crowns after 1 year is unclear. PURPOSE The purpose of this controlled, randomized, and double-blind clinical trial was to evaluate the performance of posterior complete crowns in polymer-infiltrated and lithium disilicate ceramics and to assess the impact of oral rehabilitation on esthetic satisfaction, quality of life, and periodontal health. MATERIAL AND METHODS A total of 33 crowns were provided in 18 participants allocated to 2 groups: Control (Lithium disilicate-IPS e.max CAD; Ivoclar AG) and Experimental (Polymer-infiltrated ceramic-Vita Enamic; Vita Zahnfabrik). The crowns were evaluated before treatment (T0) and after 1 (T1), 6 (T2), and 12 (T3) months by using modified United States Public Health Service (USPHS) criteria, visual analog scales (VASs), oral impacts on daily performances (OIDP), and periodontal parameters. Survival analysis was performed by using Kaplan-Meier followed by the log-rank test (α=.05). The OIDP and USPHS data were analyzed descriptively while VASs for esthetic satisfaction and periodontal parameters were statistically evaluated by using the Mann-Whitney Friedman, and Wilcoxon post hoc tests. RESULTS For 18 participants with a mean age of 47.2 years, 19 crowns were manufactured in lithium disilicate and 14 in polymer-infiltrated ceramic. The Kaplan-Meier test revealed similar survival rates of 92.5% for polymer-infiltrated ceramic and 94.7% for lithium disilicate (P>.05). The analysis of periodontal parameters revealed a significant increase in the bleeding on probing (BOP) for polymer-infiltrated ceramics (P=.032) but for lithium disilicate, it was not significant (P=.387). CONCLUSIONS Survival rates between the evaluated materials were not significantly different, with acceptable clinical performance after 1 year of follow-up.
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Affiliation(s)
- Dayanne M D Moura
- Professor, State University of Rio Grande do Norte (UERN), Department of Dentistry, Caicó, RN, Brazil
| | - Gabriela M de Araújo
- Researcher, Federal University of Rio Grande do Norte (UFRN), Department of Dentistry, Natal, RN, Brazil
| | - Lidya N M de Araújo
- PhD student, Federal University of Rio Grande do Norte (UFRN), Department of Dentistry, Natal, RN, Brazil
| | | | - Amanda M de Oliveira Dal Piva
- Assistant Professor, Academic Centre for Dentistry Amsterdam (ACTA), Universiteit van Amsterdam and Vrije Universiteit, Department of Dental Materials Science, Amsterdam, the Netherlands
| | - Mutlu Ozcan
- Professor, University of Zurich, Department of Dental Medicine, Division of Dental Biomaterials, Clinic for Reconstructive Dentistry, Zurich, Switzerland
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Duan C, Ye L, Zhang M, Yang L, Li C, Pan J, Wu Y, Cao Y. Clinical performance of zirconium implants compared to titanium implants: a systematic review and meta-analysis of randomized controlled trials. PeerJ 2023; 11:e15010. [PMID: 36949758 PMCID: PMC10026713 DOI: 10.7717/peerj.15010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/16/2023] [Indexed: 03/19/2023] Open
Abstract
Purpose To quantitatively assess and compare the clinical outcomes, including survival rate, success rate, and peri-implant indices of titanium and zirconium implants in randomized controlled trials. Methods The electronic databases searched included the Cochrane Central Register of Controlled Trials (CENTRAL), Medline via Ovid, EMBASE, and Web of Science. Randomized controlled trials (RCTs) that reported the effects of zirconium implants on primary outcomes, such as survival rate, success rate, marginal bone loss (MBL), and probing pocket depth (PPD), compared to titanium implants were included in this review. Two reviewers independently screened and selected the records, assessed their quality, and extracted the data from the included studies. Results A total of four studies from six publications reviewed were included. Two of the comparative studies were assessed at minimal risk of bias. Zirconium implants may have a lower survival rate (risk ratio (RR) = 0.91, CI [0.82-1.02], P = 0.100, I 2 = 0%) and a significantly lower success rate than titanium implants (RR = 0.87, CI [0.78-0.98], P = 0.030, I 2 = 0%). In addition, there was no difference between the titanium and zirconium implants in terms of MBL, PPD, bleeding on probing (BOP), plaque index (PI), and pink esthetic score (PES) (for MBL, MD = 0.25, CI [0.02-0.49], P = 0.033, I 2 = 0%; for PPD, MD = -0.07, CI [-0.19-0.05], P = 0.250, I 2 = 31%). Conclusion Zirconium implants may have higher failure rates due to their mechanical weakness. Zirconium implants should be strictly assessed before they enter the market. Further studies are required to confirm these findings.
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Affiliation(s)
- Chengchen Duan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, China
| | - Li Ye
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Mengyun Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, China
| | - Lei Yang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, China
| | - Chunjie Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jian Pan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yingying Wu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yubin Cao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Lemos CAA, Verri FR, de Luna Gomes JM, Santiago Junior JF, Miyashita E, Mendonça G, Pellizzer EP. Survival and prosthetic complications of monolithic ceramic implant-supported single crowns and fixed partial dentures: A systematic review with meta-analysis. J Prosthet Dent 2022:S0022-3913(22)00736-3. [PMID: 36564291 DOI: 10.1016/j.prosdent.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/15/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022]
Abstract
STATEMENT OF PROBLEM Monolithic ceramic implant-supported restorations have been used to rehabilitate partially edentulous patients. However, knowledge of the survival and prosthetic complications of single crowns (SCs) and fixed partial dentures (FPDs) is limited. PURPOSE The purpose of this systematic review with meta-analysis was to evaluate the clinical performance of monolithic ceramic implant-supported SCs and FPDs in terms of survival and prosthetic complication rates. MATERIAL AND METHODS The systematic review was registered on the prospective register of systematic reviews (PROSPERO) (CRD42017078568). Five electronic databases were independently searched by 2 authors for articles published until May 2022. In addition, a hand search was performed in the nonpeer-reviewed literature, specific journals, and reference lists of included articles. A single-arm meta-analysis was performed by using the R program. The risk of bias and quality were assessed using the Cochrane risk of bias tools and the Newcastle-Ottawa scale. RESULTS Twenty-eight studies were included in the quantitative synthesis. A total of 1298 monolithic ceramic implant-supported restorations (1116 SCs and 182 FPDs) were evaluated in 1193 participants, with a median observation time of 24 months (range: 12 to 72 months). Meta-analysis indicated the proportion of failures and prosthetic complication rates of 2% (95% confidence interval [CI]: 1% to 4%) for SCs. No difference was observed for monolithic zirconia and lithium disilicate SCs. In the FPDs, only monolithic zirconia was considered, with 1 failure reported totaling the proportion of failures of 0% (0% to 1%) and complication rates of 4% (0% to 12%). The most complications reported for both types of restorations were screw loosening, debonding, and minor chipping and were considered repairable. The included studies showed a low risk of bias and good quality. CONCLUSIONS The use of monolithic ceramic implant-supported SCs, independent of ceramic material, and monolithic zirconia implant-supported FPDs should be considered an effective and safe treatment option because of favorable short-term survival and low prosthetic complications. However, additional well-conducted studies with a longer-term follow-up and direct comparison between veneered restorations are recommended to reassess clinical performance.
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Affiliation(s)
- Cleidiel Aparecido Araujo Lemos
- Adjunct Professor, Department of Dentistry, Federal University of Juiz de Fora - Campus Governador Valadares (UFJF/GV), Governador Valadares, Minas Gerais, Brazil.
| | - Fellippo Ramos Verri
- Adjunct Professor, Departament of Dental Materials and Prosthodontics, São Paulo State Univeristy (UNESP), Araçatuba Dental School, Araçatuba, São Paulo, Brazil
| | | | - Joel Ferreira Santiago Junior
- Professor, Departament of Health Sciences, School of Dentistry, Centro Universitário Sagrado Coração-UNISAGRADO, Bauru, São Paulo, Brazil
| | - Eduardo Miyashita
- Titular Professor, Department of Dentistry, UNIP - Universidade Paulista, São Paulo, Brazil
| | - Gustavo Mendonça
- Clinical Associate Professor, Department of Biological and Material Sciences, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Eduardo Piza Pellizzer
- Titular Professor, Department of Dental Materials and Prosthodontics, Sao Paulo State University (UNESP), Araçatuba, Brazil
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Flexural Strength of Vitreous Ceramics Based on Lithium Disilicate and Lithium Silicate Reinforced with Zirconia for CAD/CAM. Int J Biomater 2022; 2022:5896511. [PMID: 35154328 PMCID: PMC8828337 DOI: 10.1155/2022/5896511] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/30/2021] [Accepted: 01/13/2022] [Indexed: 11/27/2022] Open
Abstract
The dental prosthesis market is rapidly evolving to meet patient and clinical demands. These new materials must have good flexural strength, toughness, aesthetic properties, and reliability in performance for structural applications. The present work aimed to compare the bending strength of 4 types of chairside lithium disilicate (Li2Si2O5) glass-ceramics used for dental prosthesis and to analyze the influence of heat treatment on the transformation of lithium metasilicate (Li2SiO3) into lithium disilicate. The three-ball test for the biaxial flexion test (B3B) was used. Weibull statistical analysis was used, and it showed that samples with a higher percentage of zirconia have a greater tendency to fail. The flexion tests showed that the addition of more than 10% of zirconia reduced the flexural strength. The heat treatment process improves and provides greater mechanical strength. The XRD results indicated that the samples with the lowest percentage of zirconia exhibited greater crystallinity and corroborated the microstructural analysis. SEM analyses showed a greater amount and elongated crystals of lithium disilicate when comparing samples with a higher percentage of zirconia. Therefore, samples with lower zirconia showed greater flexural strength than samples with higher additions of zirconia.
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Sol-gel preparation of ZrO 2-Li 2Si 2O 5 ceramics and their sintering properties. J Mech Behav Biomed Mater 2021; 126:105032. [PMID: 34902755 DOI: 10.1016/j.jmbbm.2021.105032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 11/20/2022]
Abstract
Despite zirconia (ZrO2) ceramics and lithium disilicate (Li2Si2O5) glass-ceramics have been widely applied on the market for dental restorations, composites that can combine the advantages of both are still demanded. Here we introduced a ZrO2-Li2Si2O5 ceramic with minimized glass phases that fabricated through a sol-gel method and subsequent pressureless sintering. ZrO2-Li2Si2O5 powders were obtained after the gel precursors were heat treated under 800 °C. The gel-derived powders were molded and pressureless sintered under 900-1000 °C to investigate their sintering properties. From the microstructures of the sintered samples, we knew that the densification process was dominated by the growth of Li2Si2O5 grains instead of the growth of ZrO2 grains. Increasing in Li2Si2O5 content can promote ceramic densification. Interestingly, reactions between ZrO2 and Li2Si2O5 were observed with sintering temperature higher than 916 °C, which can increase the porosity of the ceramics. Therefore, both the content of Li2Si2O5 and sintering temperature should be well adjusted to achieve samples with desired properties. Finally, ceramics with flexural strength of 226 MPa and porosity of 0.4% were achieved from powders with moderate Li2Si2O5 content after sintering at 1000 °C.
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Kunavisarut C, Jarangkul W, Pornprasertsuk-Damrongsri S, Joda T. Patient-reported outcome measures (PROMs) comparing digital and conventional workflows for treatment with posterior single-unit implant restorations: A randomized controlled trial: PROMs comparing digital & conventional workflows. J Dent 2021; 117:103875. [PMID: 34728252 DOI: 10.1016/j.jdent.2021.103875] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/22/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES The aim of this randomized controlled trial (RCT) was to analyze patient-reported outcome measures (PROMs) of prosthetic therapy with monolithic implant crowns in completely digital workflows (test) with intraoral optical scanning (IOS) and conventional workflows (control) with conventional impressions. Secondary, an objective evaluation of the final implant restorations was performed using the Functional Implant Prosthodontic Score (FIPS). MATERIALS AND METHODS Forty patients who required an implant-supported single crown on posterior regions were randomly divided into test (n=20) and control (n=20) groups for impression taking. Each group was then equally separated into two subgroups according to the restorative material used: lithium disilicate (LS2, N!CE®, Straumann AG, Basel, Switzerland) or polymer-infiltrated ceramic networks (PICN, Enamic®, Vita, Bad Säckingen, Germany). Patient satisfaction was evaluated using PROM questionnaires with visual analog scales (VAS) after impression-taking and 1 week after prosthetic delivery. Patient satisfaction with the impression technique was assessed in six domains: length, comfort, anxiety, taste, nausea, and pain, whereas patient satisfaction with the final restoration was assessed in four domains: overall treatment outcome, functionality, esthetics, and cleanability. In addition, the final implant restorations were objectively assessed by an independent prosthodontist using the FIPS. Mann-Whitney U test was used to analyze the defined outcomes. Statistical analysis was completed with a level of significance set at α=0.05. RESULTS PROMs focusing on the impression technique demonstrated higher levels of patient satisfaction for IOS compared to conventional impressions, especially in terms of "taste irritation" (p=0.036); whereas no significant differences were found between both restorative CAD/CAM-materials. Mean FIPS values demonstrated similar results among subgroups. CONCLUSIONS Within the limitation of this study, both completely digital and conventional protocols provided great levels of patient satisfaction in implant rehabilitation of single-tooth gaps in posterior sites with monolithic implant crowns. The restorative material, LS2 versus PICN, does not impact patient satisfaction with their treatment. However, long-term followed up is required to ensure patient' satisfaction with the restorations.
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Affiliation(s)
- Chatchai Kunavisarut
- Department of Advanced General Dentistry, Mahidol University, Bangkok, Thailand.
| | - Worapat Jarangkul
- Education Program in Implant Dentistry, Mahidol University, Bangkok, Thailand
| | | | - Tim Joda
- Department of Reconstructive Dentistry, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
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Spitznagel FA, Balmer M, Wiedemeier DB, Jung RE, Gierthmuehlen PC. Clinical outcomes of all-ceramic single crowns and fixed dental prostheses supported by ceramic implants: A systematic review and meta-analyses. Clin Oral Implants Res 2021; 33:1-20. [PMID: 34665900 PMCID: PMC9297865 DOI: 10.1111/clr.13871] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/17/2021] [Accepted: 09/28/2021] [Indexed: 02/07/2023]
Abstract
Objective To analyze the clinical outcomes of all‐ceramic single crowns (SCs) and fixed dental prostheses (FDPs) supported by ceramic implants. Materials and Methods Based on a focused question and customized PICO framework, electronic (Medline/EMBASE/Cochrane) and manual searches for studies reporting the clinical outcomes of all‐ceramic SCs and FDPs supported by ceramic implants ≥12 months were performed. The primary outcomes were reconstruction survival and the chipping proportion. The secondary outcomes were implant survival, technical complications, and patient‐related outcome measurements. Meta‐analyses were performed after 1, 2, and 5 years using random‐effect meta‐analyses. Results Eight of the 1,403 initially screened titles and 55 full texts were included. Five reported on monolithic lithium disilicate (LS2) SCs, one on veneered zirconia SCs, and two on veneered zirconia SCs and FDPs, which reported all on cement‐retained reconstructions (mean observation: 12.0–61.0 months). Meta‐analyses estimated a 5‐year survival rate of 94% (95% confidence interval [CI]: 82%–100%) for overall implant survival. Reconstruction survival proportions after 5 years were: monolithic LS2, 100% (95%CI: 95%–100%); veneered zirconia SCs, 89% (95%CI: 62%–100%); and veneered zirconia FDPs 94% (95%CI: 81%–100%). The chipping proportion after 5 years was: monolithic LS2, 2% (95%CI: 0%–11%); veneered zirconia SCs, 38% (95%CI: 24%–54%); and veneered zirconia FDPs, 57% (95%CI: 38%–76%). Further outcomes were summarized descriptively. Conclusions Due to the limited data available, only tendencies could be identified. All‐ceramic reconstructions supported by ceramic implants demonstrated promising survival rates after mid‐term observation. However, high chipping proportions of veneered zirconia SCs and, particularly, FDPs diminished the overall outcome. Monolithic LS2 demonstrated fewer clinical complications. Monolithic reconstructions could be a valid treatment option for ceramic implants.
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Affiliation(s)
- Frank Akito Spitznagel
- Department of Prosthodontics, School of Dentistry, Heinrich-Heine-University, Düsseldorf, Germany
| | - Marc Balmer
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Daniel B Wiedemeier
- Statistical Services, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ronald Ernst Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Pjetursson BE, Sailer I, Latyshev A, Rabel K, Kohal RJ, Karasan D. A systematic review and meta-analysis evaluating the survival, the failure, and the complication rates of veneered and monolithic all-ceramic implant-supported single crowns. Clin Oral Implants Res 2021; 32 Suppl 21:254-288. [PMID: 34642991 PMCID: PMC9293296 DOI: 10.1111/clr.13863] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/04/2021] [Indexed: 12/28/2022]
Abstract
Objective To assess the survival, failure, and complication rates of veneered and monolithic all‐ceramic implant‐supported single crowns (SCs). Methods Literature search was conducted in Medline (PubMed), Embase, and Cochrane Central Register of Controlled Trials until September 2020 for randomized, prospective, and retrospective clinical trials with follow‐up time of at least 1 year, evaluating the outcome of veneered and/or monolithic all‐ceramic SCs supported by titanium dental implants. Survival and complication rates were analyzed using robust Poisson's regression models. Results Forty‐nine RCTs and prospective studies reporting on 57 material cohorts were included. Meta‐analysis of the included studies indicated an estimated 3‐year survival rate of veneered‐reinforced glass‐ceramic implant‐supported SCs of 97.6% (95% CI: 87.0%–99.6%). The estimated 3‐year survival rates were 97.0% (95% CI: 94.0%–98.5%) for monolithic‐reinforced glass‐ceramic implant SCs, 96.9% (95% CI: 93.4%–98.6%) for veneered densely sintered alumina SCs, 96.3% (95% CI: 93.9%–97.7%) for veneered zirconia SCs, 96.1% (95% CI: 93.4%–97.8%) for monolithic zirconia SCs and only 36.3% (95% CI: 0.04%–87.7%) for resin‐matrix‐ceramic (RMC) SCs. With the exception of RMC SCs (p < 0.0001), the differences in survival rates between the materials did not reach statistical significance. Veneered SCs showed significantly (p = 0.017) higher annual ceramic chipping rates (1.65%) compared with monolithic SCs (0.39%). The location of the SCs, anterior vs. posterior, did not influence survival and chipping rates. Conclusions With the exception of RMC SCs, veneered and monolithic implant‐supported ceramic SCs showed favorable short‐term survival and complication rates. Significantly higher rates for ceramic chipping, however, were reported for veneered compared with monolithic ceramic SCs.
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Affiliation(s)
- Bjarni Elvar Pjetursson
- Department of Reconstructive Dentistry, Faculty of Odontology, University of Iceland, Reykjavik, Iceland.,Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Andrey Latyshev
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland.,Department of Maxillofacial, Oral and Plastic Surgery, Faculty of Dentistry, Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Kerstin Rabel
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Ralf-Joachim Kohal
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Duygu Karasan
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
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11
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El-Ma'aita A, A Al-Rabab'ah M, Abu-Awwad M, Hattar S, Devlin H. Endocrowns Clinical Performance and Patient Satisfaction: A Randomized Clinical Trial of Three Monolithic Ceramic Restorations. J Prosthodont 2021; 31:30-37. [PMID: 34378269 DOI: 10.1111/jopr.13414] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 01/16/2023] Open
Abstract
PURPOSE The purpose of this randomized, double-blind, clinical trial was to assess the survival of endocrowns made from three different monolithic ceramic materials, and to evaluate patient satisfaction. MATERIALS AND METHODS Fifty-three patients (sixty root canal treated molar teeth) were enrolled. Teeth were prepared to a flat butt-joint margin and randomly divided between three material groups: lithium disilicate-reinforced glass-ceramic, monolithic zirconia and polymer infiltrated hybrid ceramic. Predefined cementation protocols were used. Clinical assessment using modified United States Public Health Service (USPHS) criteria was carried out after two years by two independent clinicians blinded to the material used. Radiographic examination was conducted to check for the presence of caries, excess cement, and periapical infection. Statistical analysis was performed using the Kruskal Wallis and Wilcoxon signed-rank tests as well as the Kaplan-Meier survival estimate. RESULTS Forty-eight patients were available for assessment after 2 years (recall rate 90.6%). The overall Kaplan-Meier survival estimate among all groups was 90.9% with no statistically significant difference between the groups (p = 0.17). Three zirconia endocrowns debonded after 9, 10 and 13 months (82.4% survival rate), while 2 hybrid ceramic endocrowns chipped/fractured (89.5% survival rate). Lithium disilicate endocrowns had a 100% survival rate. The Kruskal Wallis test revealed no statistically significant difference between the groups in the USPHS criteria ratings and the radiographic assessment (P>0.05). Patient satisfaction ranged from 82.3% in the zirconia group to 100% in both the lithium disilicate and hybrid ceramic groups. CONCLUSIONS Endocrowns provide a predictable option for the restoration of endodontically treated molar teeth in the short term. Lithium disilicate-reinforced ceramic had fewer complications and required less intervention compared with zirconia and hybrid ceramics. Long-term follow-up is required to substantiate these study results.
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Affiliation(s)
| | | | | | - Susan Hattar
- School of Dentistry, University of Jordan, Amman, Jordan
| | - Hugh Devlin
- Division of Dentistry, The University of Manchester, Manchester, UK
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12
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In Vitro Investigations in a Biomimetic Approach to Restore One-Piece Zirconia Implants. MATERIALS 2021; 14:ma14164361. [PMID: 34442883 PMCID: PMC8400740 DOI: 10.3390/ma14164361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/27/2021] [Accepted: 07/31/2021] [Indexed: 11/21/2022]
Abstract
The objective of this study was to evaluate the fracture load and retention force of different bonding systems while restoring one-piece zirconia implants with a novel cementation approach using a mesostructure. Polymer-infiltrated ceramic mesostructures (n = 112) were therefore designed as caps on the implant abutment, and a molar feldspathic ceramic crown was constructed on top of it as a suprastructure. For cementation, different bonding systems were used. Fracture load and retention force were measured immediately after storage in water at 37 °C for 24 h (n = 8) as well as after artificial aging in a chewing simulator and subsequent thermal cycling (n = 8). Combined restorations showed higher fracture load compared to monolithic restorations of polymer-infiltrated ceramic (n = 8) or feldspathic ceramic (n = 8) identical in shape. However, the fracture load of the combined restorations was significantly affected by aging, independent of the primers and cements used. Restorations cemented with primers containing methyl methacrylate and 10-methacryloyloxydecyl dihydrogen phosphate exhibited the highest retention force values. Aging did not affect the retention force significantly. Similar fracture load values can be expected from combination restorations when compared with monolithic crowns.
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13
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Laumbacher H, Strasser T, Knüttel H, Rosentritt M. Long-term clinical performance and complications of zirconia-based tooth- and implant-supported fixed prosthodontic restorations: A summary of systematic reviews. J Dent 2021; 111:103723. [PMID: 34119611 DOI: 10.1016/j.jdent.2021.103723] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/21/2021] [Accepted: 06/02/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To present an overview on systematic reviews on prosthodontic zirconia restorations and to discuss long-term complications as well as information on anatomical and functional changes to the masticatory system. DATA/SOURCES MEDLINE, EMBASE, Trip medical, and Cochrane Library databases were searched for systematic reviews up to February 2021. Bias was assessed and clinical survival and complications were analyzed. STUDY SELECTION 38 eligible articles published between 2006 and 2021 were included. The reviews were based on 128 in vivo studies on approximately 10,000 zirconia restorations. 5-year cumulative survival rates varied between 91.2% and 95.9% for tooth-supported (TS) single crowns (SC), 89.4% and 100% for TS multi-unit fixed dental prostheses (FDP), 97.1% and 97.6% for implant-supported (IS) SCs and 93.0% and 100% for IS FDPs. Chipping was the most often technical complication, followed by framework fracture, loss of retention, marginal discrepancies/discoloration, occlusal roughness and abutment/screw loosening. Color mismatch was the only esthetic complication. Biological complications were caries, endodontic complications, tooth fracture, periodontal disease, abrasion/attrition, persisting pain, high sensitivity, peri‑implantitis and soft tissue issues. Patients with bruxism were only examined sporadically. CONCLUSIONS 5-year results for zirconia restorations were satisfactory. The predominant technical problem of veneering fractures could be overcome with adapted design or fabrication and application of monolithic restorations, but reviews of clinical studies on this subject are rare. The impact of zirconia restorations on the masticatory system remains unclear. CLINICAL SIGNIFICANCE Zirconia restorations are experiencing a rapidly increasing use in dental practice. Being highly wear-resistant, hard and durable, it can be assumed that they do not follow natural abrasion and changes in the masticatory system. Possible long-term effects on the stomatognathic system as a whole should therefore be considered.
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Affiliation(s)
- Harald Laumbacher
- Department of Prosthetic Dentistry, UKR University Hospital Regensburg, 93042 Regensburg, Germany
| | - Thomas Strasser
- Department of Prosthetic Dentistry, UKR University Hospital Regensburg, 93042 Regensburg, Germany
| | - Helge Knüttel
- University Library, University of Regensburg, 93042 Regensburg, Germany
| | - Martin Rosentritt
- Department of Prosthetic Dentistry, UKR University Hospital Regensburg, 93042 Regensburg, Germany.
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14
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Spitznagel FA, Bonfante EA, Vollmer F, Gierthmuehlen PC. Failure Load of Monolithic Lithium Disilicate Implant-Supported Single Crowns Bonded to Ti-base Abutments versus to Customized Ceramic Abutments after Fatigue. J Prosthodont 2021; 31:136-146. [PMID: 33870577 DOI: 10.1111/jopr.13369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This laboratory study analyzed the influence of retention mode (screw- vs cement retained) and fatigue application on the failure load of monolithic lithium-disilicate (LDS) implant-supported single crowns (ISSC). MATERIAL AND METHODS A total of 72 samples of monolithic LDS (*Ivoclar Vivadent) ISSC were divided into three groups (n = 24) according to their type of retention mode: Group Ti-CAD: Titanium base (SICvantage CAD/CAM Abutment red (SIC invent AG), screw-retained milled monolithic LDS (IPS e.max CAD*); Group Ti-P: Titanium base (SICvantage CAD/CAM Abutment red), screw-retained pressed monolithic LDS (IPS e.max Press*) and Group Ti-Cust: Titanium base with cemented press LDS (IPS e.max Press*) crown on a LDS (IPS e.max Press*) custom abutment. A mandibular first molar implant-supported single crown model was investigated (Titanium implant: SICvantage-max, SIC invent AG, diameter: 4.2 mm, length: 11.5 mm). Half of each group (n = 12) were exposed to fatigue with cyclic mechanical loading (F = 198 N, 1.2 million cycles) and simultaneous thermocycling (5-55°C). Single load to failure testing was performed, before (Subgroups Ti-CAD, Ti-P, and Ti-Cust) and after (Subgroups Ti-CAD-F, Ti-P-F, and Ti-Cust-F) fatigue. Weibull distribution was used to determine the characteristic strength and Weibull modulus differences between groups. Probability of survival at 900N load was calculated. RESULTS No samples failed during fatigue. Characteristic strength values were as follow: Ti-CAD: 3259.5N, Ti-CAD-F: 2926N, Ti-P: 2763N, Ti-P-F: 2841N, Ti-Cust: 2789N, Ti-Cust-F: 2194N. Whereas no difference was observed between pressed or milled monolithic crowns cemented to Ti-base, regardless of loading condition, fatigue decreased the characteristic strength of crowns cemented to custom abutments. Probability of survival at 900 N was not significantly different between groups. CONCLUSIONS Screw-retained pressed or milled monolithic LDS ISSC, cemented directly to Ti-base abutments or LDS crowns cemented to custom ceramic abutments resist physiological chewing forces after simulated 5-year aging in the artificial mouth and presented equally high probability of survival. However, a significant decrease in load to failure was observed in LDS crowns cemented to custom ceramic abutments after fatigue. Prospective clinical trials are needed to confirm the results of this laboratory investigation.
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Affiliation(s)
- F A Spitznagel
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - E A Bonfante
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru, SP, Brazil
| | - F Vollmer
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.,Private Practice, Tettnang, Germany
| | - P C Gierthmuehlen
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
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15
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Spitznagel FA, Röhrig S, Langner R, Gierthmuehlen PC. Failure Load and Fatigue Behavior of Monolithic Translucent Zirconia, PICN and Rapid-Layer Posterior Single Crowns on Zirconia Implants. MATERIALS 2021; 14:ma14081990. [PMID: 33921126 PMCID: PMC8071484 DOI: 10.3390/ma14081990] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 11/16/2022]
Abstract
This laboratory study aimed to evaluate the thermo-mechanical fatigue behavior and failure modes of monolithic and rapid-layer posterior single-crowns (SCs) supported by zirconia implants. Methods: 120 all-ceramic crowns supported by one-piece zirconia implants (ceramic.implant; vitaclinical) were divided into five groups (n = 24 each): Group Z-HT: 3Y-TZP monolithic-zirconia (Vita-YZ-HT); Group Z-ST: 4Y-TZP monolithic-zirconia (Vita-YZ-ST); Z-XT: 5Y-TZP monolithic-zirconia (Vita-YZ-XT); Group E: monolithic-polymer-infiltrated ceramic network (PICN,Vita-Enamic); Group RL (rapid layer): PICN-“table-top” (Vita-Enamic), 3Y-TZP-framework (Vita-YZ-HT). Half of the specimens of each group (n = 12) were exposed to fatigue with cyclic mechanical loading (F = 198N, 1.2-million cycles) and simultaneous thermocycling (5–55 °C). Single-load-to-failure testing (Z010, Zwick) was performed for all specimens without/with fatigue application. Data analysis was performed using ANOVA, Tukey’s post-hoc test, two-sample t-test and Bonferroni correction (p < 0.05). Results: All specimens survived fatigue exposure. Significant differences in failure loads were detected among groups (p ≤ 0.004). Materials Z-HT and Z-ST showed the highest failure loads followed by Z-XT, RL and E. The influence of fatigue was only significant for material RL. Conclusions: All types of tested materials exceeded clinically acceptable failure load values higher than 900N and can be recommended for clinical use. Z-HT and Z-ST appear to be highly reliable towards fatigue. Rapid-layer design of PICN and YZ-HT might be an interesting treatment concept for posterior implant SCs.
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Affiliation(s)
- Frank A. Spitznagel
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, 40225 Düsseldorf, Germany; (S.R.); (P.C.G.)
- Correspondence: ; Tel.: +49-211-81-04440
| | - Sara Röhrig
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, 40225 Düsseldorf, Germany; (S.R.); (P.C.G.)
| | - Robert Langner
- Institute of Systems Neuroscience, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany;
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Centre Jülich, 52425 Jülich, Germany
| | - Petra C. Gierthmuehlen
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, 40225 Düsseldorf, Germany; (S.R.); (P.C.G.)
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16
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Rohr N, Märtin S, Fischer J. Fracture load of zirconia implant supported CAD/CAM resin crowns and mechanical properties of restorative material and cement. J Prosthodont Res 2021; 65:502-508. [PMID: 33840705 DOI: 10.2186/jpr.jpr_d_20_00051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE To test if resin CAD/CAM materials should be considered for zirconia implants and how their mechanical properties affect the fracture load. METHODS Fracture load of molar crowns of CAD/CAM materials (VITA CAD-Temp [CT], Cerasmart [CS], Lava Ultimate [LU], Pekkton Ivory [PK]) on zirconia implants (ceramic.implant, 4.0 mm) fixed either with no cement, temporary cement (Harvard Implant semi-permanent [HIS]), self-adhesive (VITA Adiva S-Cem [VAS]) or either one of two adhesive cements (Multilink Automix [MLA], VITA Adiva F-Cem [VAF]) was analyzed. The restorative materials were characterized by their flexural strength, fracture toughness, elemental composition and organic/inorganic ratio while compressive strength of the cements was measured. RESULTS For the fracture load significantly highest mean values were fo und overall for PK (2921 ±300 N) > LU (2017 ±499 N) > CS (1463 ±367 N) = CT (1451 ±327 N) (p > 0.05). When analyzing the effect of the cement on the fracture load the overall ranking was VAF (2245 ±650 N) ≥ MLA (2188 ±708 N) ≥ VAS (2017 ±563 N) > HIS (1757 ±668 N) = no cement (1595 ±757 N) (p <0.05), meaning fracture load increased with the compressive strength of the cements. Additionally, a linear trend was found between the fracture load and the fracture toughness of the restorative materials. CONCLUSIONS All restorative materials exhibited fracture load values similar or higher than lithium disilicate tested previously. Fracture load of CT, CS and LU can be significantly increased when an adhesive cement with a high compressive strength is used.
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Affiliation(s)
- Nadja Rohr
- Biomaterials and Technology, Department of Reconstructive Dentistry, University Center for Dental Medicine, University of Basel, Basel
| | - Sabrina Märtin
- Biomaterials and Technology, Department of Reconstructive Dentistry, University Center for Dental Medicine, University of Basel, Basel
| | - Jens Fischer
- Biomaterials and Technology, Department of Reconstructive Dentistry, University Center for Dental Medicine, University of Basel, Basel
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17
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DuVall NB, DeReis SP, Vandewalle KS. Fracture strength of various titanium-based, CAD-CAM and PFM implant crowns. J ESTHET RESTOR DENT 2020; 33:522-530. [PMID: 33174333 DOI: 10.1111/jerd.12672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/28/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE CAD-CAM has dramatically advanced dental restorative procedures to include implant-supported crowns. The purpose of this study was to compare the fracture resistance following mechanical loading and thermocycling of various screw-retained and cement-retained ceramic and polymethylmethacrylate material combinations using the TiBase abutment compared to PFM implant-supported crowns. OVERVIEW Twelve implant restorations were fabricated for each of eight groups. Three groups were screw-retained and five groups were cement-retained implant restorations. The ceramic and polymethylmethacrylate restorations were fabricated on the TiBase abutment while the PFM restorations were fabricated on an UCLA abutment. Data were analyzed with a one way Analysis of Variance and Tukey's post-hoc test to evaluate the effect of abutment and crown type on fracture load (alpha = 0.05). A significant difference was found in the maximum fracture load between groups (P < 0.001). CONCLUSIONS The screw-retained implant restorations demonstrated higher fracture loads than their cement-retained counterparts. The TiBase abutment compared favorably to the UCLA abutment. CLINICAL SIGNIFICANCE The TiBase abutment is a titanium insert which combines the esthetics of a ceramic abutment with the mechanical properties of a titanium abutment and should be considered a viable clinical alternative to the conventional implant-supported PFM crown based on theses in vitro results and in context of in vivo studies. The lithium disilicate hybrid abutment/crown implant-supported restoration utilizing the TiBase abutment may be an ideal clinical choice due to simplicity, single appointment CAD-CAM, and esthetics.
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Affiliation(s)
- Nicholas B DuVall
- Program Director, AEGD Residency, 96th Dental Squadron, Eglin AFB, Florida, USA.,US Air Force Postgraduate Dental College, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Stephen P DeReis
- Certified Dental Technician, 81st Dental Squadron, Keesler AFB, Mississippi, USA
| | - Kraig S Vandewalle
- US Air Force Postgraduate Dental College, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Director of Dental Research, AEGD Residency, 59th Dental Training Squadron, Joint Base San Antonio-Lackland, Texas, USA
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18
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Digitization of One-Piece Oral Implants: A Feasibility Study. MATERIALS 2020; 13:ma13081990. [PMID: 32344639 PMCID: PMC7215390 DOI: 10.3390/ma13081990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/13/2020] [Accepted: 04/23/2020] [Indexed: 11/16/2022]
Abstract
For digital impression-making of two-piece oral implants, scan bodies are used to transfer the exact intraoral implant position to the dental laboratory. In this in vitro investigation, the accuracy of digitizing a one-piece ceramic oral implant without a scan body (OC) was compared to that of a standard two-piece titanium implant with a scan body (TT) and a preparation of a natural single tooth (ST). Furthermore, incomplete scans of OC simulating clinical compromising situations (OC1–4) were redesigned using a virtual reconstruction tool (RT) and superimposed to OC. OC and TT oral implants and one ST were inserted into a mandible typodont model and digitized (N = 13) using two different intraoral scanners. The resulting virtual datasets were superimposed onto a three-dimensional (3D) laser scanner-based reference. Test and reference groups were aligned using an inspection software according to a best-fit algorithm, and circumferential as well as marginal discrepancies were measured. For the statistical evaluation, multivariate analyses of variance with post-hoc Tukey tests and students t-tests to compare both scanners were performed. A total of 182 datasets were analyzed. For circumferential deviations, no significant differences were found between ST, TT, and OC (p > 0.964), but increased deviations for OC1–4 (p < 0.001) were observed. The measurements of the marginal deviations revealed that ST had the smallest deviations, and that there were no significant differences between TT, OC, and OC1–4 (p > 0.979). Except for marginal deviation of OC (p < 0.001), the outcome was not affected by the scanner. Within the limitations of this study, digitization of OC is as accurate as that of TT, but less than that of ST. In the case of known geometries, post-processing of compromised scans with a virtual reconstruction results in accurate data.
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19
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Ceramic Materials and Technologies Applied to Digital Works in Implant-Supported Restorative Dentistry. MATERIALS 2020; 13:ma13081964. [PMID: 32331379 PMCID: PMC7216107 DOI: 10.3390/ma13081964] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/14/2020] [Accepted: 04/20/2020] [Indexed: 12/17/2022]
Abstract
Computer-aided design and manufacturing technology has been closely associated with implant-supported restoration. The digital system employed for prosthodontic restorations comprises data acquisition, processing, and manufacturing using subtractive or additive methods. As digital implantology has developed, optical scanning, computer-based digital algorithms, fabricating techniques, and numerical control skills have all rapidly improved in terms of their accuracy, which has resulted in the development of new ceramic materials with advanced esthetics and durability for clinical application. This study reviews the application of digital technology in implant-supported dental restoration and explores two globally utilized ceramic restorative materials: Yttria-stabilized tetragonal zirconia polycrystalline and lithium disilicate glass ceramics.
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20
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Ortiz AL, Rodrigues CS, Guiberteau F, Zhang Y. An in situ and ex situ study of the microstructural evolution of a novel lithium silicate glass-ceramic during crystallization firing. Dent Mater 2020; 36:645-659. [PMID: 32278481 DOI: 10.1016/j.dental.2020.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/16/2020] [Accepted: 03/12/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To elucidate the compositional and microstructural developments of a novel lithium silicate glass-ceramic during its crystallization cycle. METHODS Blocks of a lithium silicate glass-ceramic (Obsidian®, Glidewell Laboratories) were cut into 1mm thick plates and polished to 1μm finish. Some of them were crystallized prior to polishing. Firstly, ex situ compositional and microstructural characterizations of both the pre- and post-crystallized samples were performed by wavelength dispersive X-ray fluorescence, field-emission scanning electron microscopy, and X-ray diffractometry. Secondly, the pre-crystallized samples were subjected to in situ compositional and microstructural characterizations under non-isothermal heating by simultaneous thermogravimetry/differential scanning calorimetry, X-ray thermo-diffractometry, and field-emission scanning electron thermo-microscopy. RESULTS The microstructure of pre-crystallized Obsidian® consists of an abundant population of perlitic-like/dendritic lithium silicate (Li2SiO3) nanocrystals in a glass matrix. Upon heating, the residual glassy matrix does not crystallize into any form of SiO2; elemental oxides do not precipitate unless over-heated above 820°C; and the Li2SiO3 nanocrystals do not react with the glassy matrix to form typical lithium disilicate (Li2Si2O5) crystals. Nonetheless, the Li2SiO3 nanocrystals grow and spheroidize through the solution-reprecipitation process in the softened glass, and new lithium orthophosphate (Li3PO4) nanocrystals precipitate from the glass matrix. SIGNIFICANCE The identification of compositional and microstructural developments of Obsidian® indicates that, by controlling the firing conditions, it is possible to tailor its microstructure, which in turn could affect its mechanical and optical properties, and ultimately its clinical performance.
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Affiliation(s)
- Angel L Ortiz
- Departamento de Ingeniería Mecánica, Energética y de los Materiales, Universidad de Extremadura, 06006 Badajoz, Spain.
| | - Camila S Rodrigues
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, NY 10010, USA; Programa de Pós-Graduação em Ciências Odontológicas, Universidade Federal de Santa Maria, Santa Maria, Brazil
| | - Fernando Guiberteau
- Departamento de Ingeniería Mecánica, Energética y de los Materiales, Universidad de Extremadura, 06006 Badajoz, Spain
| | - Yu Zhang
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, NY 10010, USA
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21
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Long-term performance of implant-supported metal-ceramic and all-ceramic single crowns. J Prosthodont Res 2019; 64:332-339. [PMID: 31859082 DOI: 10.1016/j.jpor.2019.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 08/26/2019] [Accepted: 09/17/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate failure rates and incidence of chipping for metal-ceramic and all-ceramic implant-supported single crowns (SCs). METHODS Six hundred and fifty-two implant-supported SCs placed in 404 patients (mean age: 57.8 years; 193 male; mean SCs per patient: 1.6) were evaluated up to 12.8 years. The frameworks of the SCs were made from Au alloys (n = 319), CoCr (n = 37), zirconia (n = 286), or lithium disilicate (n = 10). Full-coverage ceramic veneers were placed on 319 Au SCs, 34 CoCr SCs, and 92 zirconia SCs. One hundred and fifty-two monolithic zirconia SCs were not veneered. A partial veneer was placed on the buccal surface only of a further 42 zirconia SCs. RESULTS A total of 26 failures were caused by loss of implants (n = 6), ceramic fractures and chipping (n = 15), loosening of the abutment (n = 4), or swallowing of a de-cemented SC (n = 1). Kaplan-Meier analysis revealed a probability of survival of 96% after five years and 92% after 10 years. A greater incidence of failure was observed for lithium disilicate and zirconia SCs than for metal-ceramic SCs (p < .05). Separate analysis of the most frequent complication, chipping (n = 61), revealed that zirconia and lithium disilicate frameworks were significant risk factors for chipping (p < 0.05). Furthermore, a significantly greater incidence of chipping was observed for SCs with full-coverage veneers than for monolithic zirconia SCs and for SCs with partial veneers (p < .05). CONCLUSION Avoidance of full-coverage veneers significantly improves the clinical performance of implant-supported crowns, primarily reduces the incidence of chipping.
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22
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Tribst JP, Kohn BM, de Oliveira Dal Piva AM, Spinola MS, Borges AL, Andreatta Filho OD. Influence of restoration thickness on the stress distribution of ultrathin ceramic onlay rehabilitating canine guidance: a 3D-finite element analysis. ACTA ACUST UNITED AC 2019; 68:126-131. [PMID: 31014062 DOI: 10.23736/s0026-4970.19.04183-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The rehabilitation of canine guidance can be performed with adhesive indirect materials, but can the restoration thickness be reduced without mechanical disadvantages? Thus the goal of this study was to analyze the stress of upper canines which received different thicknesses of ceramic fragments for the rehabilitation of the canine guidance using finite element analysis. METHODS A superior canine was modeled using a computer aided design software. The dental tissues were individually shaped containing enamel, dentin and periodontal ligament. The following three different ceramic fragment thicknesses were then implemented: 0.3, 0.7 and 1.5 mm. Lithium disilicate was chosen as the ceramic material. The solid geometries were exported to the analysis software. The materials were considered isotropic, homogeneous and linear. The set was submitted to efforts in the incisal third in the palatine face to analyze maximal principal stress, mimicking mandibular lateral movement. The applied load was 100N, and the fixation region was on the medullary bone. RESULTS For restoration, the thinner the ceramic, the higher the stress concentration was; while for the adhesive surface of teeth, the thicker the ceramic, the higher the stress concentration. CONCLUSIONS The smaller the ceramic thickness was, the lower stress concentration showed at the adhesive interface, while the stress concentration was higher on the restoration intaglio surface.
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Affiliation(s)
- João P Tribst
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University, Unesp, São José dos Campos, SP, Brazil
| | - Bianca M Kohn
- Institute of Science and Technology, São Paulo State University, Unesp, São José dos Campos, SP, Brazil
| | - Amanda M de Oliveira Dal Piva
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University, Unesp, São José dos Campos, SP, Brazil -
| | - Manuela S Spinola
- Department of Restorative Dentistry, Institute of Science and Technology, São Paulo State University, Unesp, São José dos Campos, SP, Brazil
| | - Alexandre L Borges
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University, Unesp, São José dos Campos, SP, Brazil
| | - Osvaldo D Andreatta Filho
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University, Unesp, São José dos Campos, SP, Brazil
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Zhang Y, Tian J, Wei D, Di P, Lin Y. Quantitative clinical adjustment analysis of posterior single implant crown in a chairside digital workflow: A randomized controlled trial. Clin Oral Implants Res 2019; 30:1059-1066. [DOI: 10.1111/clr.13519] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/20/2019] [Accepted: 07/08/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Yifan Zhang
- Department of Oral Implantology Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology Beijing China
| | - Jiehua Tian
- Department of Oral Implantology Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology Beijing China
| | - Donghao Wei
- Department of Oral Implantology Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology Beijing China
| | - Ping Di
- Department of Oral Implantology Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology Beijing China
| | - Ye Lin
- Department of Oral Implantology Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology Beijing China
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Zarone F, Di Mauro MI, Ausiello P, Ruggiero G, Sorrentino R. Current status on lithium disilicate and zirconia: a narrative review. BMC Oral Health 2019; 19:134. [PMID: 31272441 PMCID: PMC6610968 DOI: 10.1186/s12903-019-0838-x] [Citation(s) in RCA: 156] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 06/27/2019] [Indexed: 01/28/2023] Open
Abstract
Background The introduction of the new generation of particle-filled and high strength ceramics, hybrid composites and technopolymers in the last decade has offered an extensive palette of dental materials broadening the clinical indications in fixed prosthodontics, in the light of minimally invasive dentistry dictates. Moreover, last years have seen a dramatic increase in the patients’ demand for non-metallic materials, sometimes induced by metal-phobia or alleged allergies. Therefore, the attention of scientific research has been progressively focusing on such materials, particularly on lithium disilicate and zirconia, in order to shed light on properties, indications and limitations of the new protagonists of the prosthetic scene. Methods This article is aimed at providing a narrative review regarding the state-of-the-art in the field of these popular ceramic materials, as to their physical-chemical, mechanical and optical properties, as well as to the proper dental applications, by means of scientific literature analysis and with reference to the authors’ clinical experience. Results A huge amount of data, sometimes conflicting, is available today. Both in vitro and in vivo studies pointed out the outstanding peculiarities of lithium disilicate and zirconia: unparalleled optical and esthetic properties, together with high biocompatibility, high mechanical resistance, reduced thickness and favorable wear behavior have been increasingly orientating the clinicians’ choice toward such ceramics. Conclusions The noticeable properties and versatility make lithium disilicate and zirconia materials of choice for modern prosthetic dentistry, requiring high esthetic and mechanical performances combined with a minimal invasive approach, so that the utilization of such metal-free ceramics has become more and more widespread over time.
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Affiliation(s)
- Fernando Zarone
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University "Federico II" of Naples, Viale Pansini, 5 -, 80131, Naples, Italy
| | - Maria Irene Di Mauro
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University "Federico II" of Naples, Viale Pansini, 5 -, 80131, Naples, Italy.
| | - Pietro Ausiello
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University "Federico II" of Naples, Viale Pansini, 5 -, 80131, Naples, Italy
| | - Gennaro Ruggiero
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University "Federico II" of Naples, Viale Pansini, 5 -, 80131, Naples, Italy
| | - Roberto Sorrentino
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University "Federico II" of Naples, Viale Pansini, 5 -, 80131, Naples, Italy
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25
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Rohr N, Balmer M, Müller JA, Märtin S, Fischer J. Chewing simulation of zirconia implant supported restorations. J Prosthodont Res 2019; 63:361-367. [DOI: 10.1016/j.jpor.2019.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 02/01/2019] [Accepted: 02/13/2019] [Indexed: 11/28/2022]
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26
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Grzech-Leśniak K, Bencharit S, Dalal N, Mroczka K, Deeb JG. In Vitro Examination of the Use of Er:YAG Laser to Retrieve Lithium Disilicate Crowns from Titanium Implant Abutments. J Prosthodont 2019; 28:672-676. [PMID: 31125150 DOI: 10.1111/jopr.13077] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2019] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Removal of cement-retained implant crowns can be difficult and often requires sectioning of the prosthesis by rotary instruments. This study aimed to measure how much time is required in crown removal and the temperature changes when erbium-doped yttrium aluminum garnet (Er:YAG) laser was used to retrieve lithium disilicate crowns from titanium implant abutments luted with composite resin (CR) cement and resin-modified glass ionomer (RMGI). MATERIALS AND METHODS Forty identical lithium disilicate crowns were fabricated for prefabricated titanium abutments. CR and RMGI cements were used to lute the crowns, 20 specimens for each cement. Specimens were kept in 100% humidity for 48 hours. Er:YAG laser was then used to facilitate the crown retrieval. The retrieval time was recorded. The temperature changes at the abutment level for each type of cement were recorded during irradiation of 10 specimens for each type of cement from 1 to 10 minutes. Data were analyzed using t-test (ɑ = 0.01) and paired t-test (ɑ = 0.05). The surfaces of the crown and the abutment were further examined using scanning electron microscopy (SEM). RESULTS The average times of crown removal from titanium abutments were 196.5 seconds for CR and 97.5 seconds for RMGI groups with statistical significance (p < 0.001). The temperatures measured from 1 to 10 minutes of irradiation ranged from 18° to 20.8° for CR and 18° to 23° for RMGI at the abutment surface, and 22.1° to 24.6° for CR and 22° to 24.8° for RMGI at the crown surface. No statistical differences were observed between temperature changes at the abutment or the crown for each cement (p = 0.63); however, there was a statistically significant difference between the temperatures at the abutment and crown for both cements (p < 0.001). SEM examination showed no visible damage caused by treatment with Er:YAG laser. CONCLUSIONS It is faster to remove lithium disilicate crowns from titanium implant abutments when luted with RMGI compared to CR cement. The temperature rise was higher in the crown compared to the abutment. The type of cement had no effects on temperature changes. Heat generated from Er:YAG irradiation does not appear to be high enough to have any adverse effect on implant osseointegration.
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Affiliation(s)
| | - Sompop Bencharit
- Department of General Practice, School of Dentistry, Virginia Commonwealth University, Richmond, VA.,Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, Richmond, VA
| | - Nishchal Dalal
- School of Dentistry, Virginia Commonwealth University, Richmond, VA
| | | | - Janina Golob Deeb
- Department of Periodontics, School of Dentistry, Virginia Commonwealth University, Richmond, VA
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27
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Mangano FG, Hauschild U, Veronesi G, Imburgia M, Mangano C, Admakin O. Trueness and precision of 5 intraoral scanners in the impressions of single and multiple implants: a comparative in vitro study. BMC Oral Health 2019; 19:101. [PMID: 31170969 PMCID: PMC6555024 DOI: 10.1186/s12903-019-0792-7] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Until now, a few studies have addressed the accuracy of intraoral scanners (IOSs) in implantology. Hence, the aim of this in vitro study was to assess the accuracy of 5 different IOSs in the impressions of single and multiple implants, and to compare them. METHODS Plaster models were prepared, representative of a partially edentulous maxilla (PEM) to be restored with a single crown (SC) and a partial prosthesis (PP), and a totally edentulous maxilla (TEM) to be restored with a full-arch (FA). These models were scanned with a desktop scanner, to capture reference models (RMs), and with 5 IOSs (CS 3600®, Trios3®, Omnicam®, DWIO®, Emerald®); 10 scans were taken for each model, using each IOS. All IOS datasets were loaded into a reverse-engineering software where they were superimposed on the corresponding RMs, to evaluate trueness, and superimposed on each other within groups, to determine precision. A statistical analysis was performed. RESULTS In the SC, CS 3600® had the best trueness (15.2 ± 0.8 μm), followed by Trios3® (22.3 ± 0.5 μm), DWIO® (27.8 ± 3.2 μm), Omnicam® (28.4 ± 4.5 μm), Emerald® (43.1 ± 11.5 μm). In the PP, CS 3600® had the best trueness (23 ± 1.1 μm), followed by Trios3® (28.5 ± 0.5 μm), Omnicam® (38.1 ± 8.8 μm), Emerald® (49.3 ± 5.5 μm), DWIO® (49.8 ± 5 μm). In the FA, CS 3600® had the best trueness (44.9 ± 8.9 μm), followed by Trios3® (46.3 ± 4.9 μm), Emerald® (66.3 ± 5.6 μm), Omnicam® (70.4 ± 11.9 μm), DWIO® (92.1 ± 24.1 μm). Significant differences were found between the IOSs; a significant difference in trueness was found between the contexts (SC vs. PP vs. FA). In the SC, CS 3600® had the best precision (11.3 ± 1.1 μm), followed by Trios3® (15.2 ± 0.8 μm), DWIO® (27.1 ± 10.7 μm), Omnicam® (30.6 ± 3.3 μm), Emerald® (32.8 ± 10.7 μm). In the PP, CS 3600® had the best precision (17 ± 2.3 μm), followed by Trios3® (21 ± 1.9 μm), Emerald® (29.9 ± 8.9 μm), DWIO® (34.8 ± 10.8 μm), Omnicam® (43.2 ± 9.4 μm). In the FA, Trios3® had the best precision (35.6 ± 3.4 μm), followed by CS 3600® (35.7 ± 4.3 μm), Emerald® (61.5 ± 18.1 μm), Omnicam® (89.3 ± 14 μm), DWIO® (111 ± 24.8 μm). Significant differences were found between the IOSs; a significant difference in precision was found between the contexts (SC vs. PP vs. FA). CONCLUSIONS The IOSs showed significant differences between them, both in trueness and in precision. The mathematical error increased in the transition from SC to PP up to FA, both in trueness than in precision.
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Affiliation(s)
- Francesco Guido Mangano
- Department of Prevention and Communal Dentistry, Sechenov First Moscow State Medical University, Moscow, Russia.
| | - Uli Hauschild
- Department of Post-graduate Education, Faculty of Oral and Dental Medicine, J.W. Goethe University, Frankfurt, Germany
| | - Giovanni Veronesi
- Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine, University of Varese, Varese, Italy
| | | | - Carlo Mangano
- Department of Dental Sciences, Vita and Salute University San Raffaele, Milan, Italy
| | - Oleg Admakin
- Department of Prevention and Communal Dentistry, Sechenov First Moscow State Medical University, Moscow, Russia
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Spies BC, Balmer M, Jung RE, Sailer I, Vach K, Kohal RJ. All-ceramic single crowns supported by zirconia implants: 5-year results of a prospective multicenter study. Clin Oral Implants Res 2019; 30:466-475. [PMID: 30972828 DOI: 10.1111/clr.13433] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 04/02/2019] [Accepted: 04/02/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To assess survival/success rates and patient-reported outcome of zirconia-based posterior single crowns (SCs) supported by zirconia implants in a prospective two-center study after five years of observation. MATERIAL AND METHODS Forty-five patients were restored with 45 zirconia implant-supported posterior SCs composed of zirconia frameworks hand-layered with a leucite-reinforced feldspathic ceramic. Survival rates of SCs were assessed and technical success was evaluated according to modified United States Public Health Care (USPHS) criteria. Furthermore, patient-reported outcome measures (PROMs) were assessed by applying visual analog scales (VAS). Wilcoxon matched-pairs signed-rank test, mixed-effects ordered logistic regression, and linear mixed models were used to evaluate time effects on response variables. RESULTS Forty patients were available after a mean observation period of 61.0 ± 1.4 months. One SC had to be replaced, resulting in a Kaplan-Meier (KM) survival estimate for the SCs of 97.5 ± 2.47%. Since nine reconstructions showed at least in one category a major deviation from the ideal (five major chippings, four with increased occlusal roughness, one significant crevice, and one pronounced over-contouring), the KM success estimate was 79.3 ± 5.8%. Incidence of chipping (n = 19) and occlusal roughness (n = 35) was frequent (p < 0.001). All PROMs at prosthetic delivery except for speech (p = 0.139) showed significantly improved VAS scores (81%-94%; p < 0.001) compared to pre-treatment evaluations. Thereafter, no decrease in satisfaction could be observed until the 5-year follow-up (93%-97%). CONCLUSION Veneered zirconia-based SCs supported by zirconia implants showed high survival rates and highly satisfied patients' needs. However, significant incidence of technical complications is compromising the clinical long-term outcome for this indication.
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Affiliation(s)
- Benedikt C Spies
- Department of Prosthetic Dentistry, Center for Dental Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Berlin, Germany
| | - Marc Balmer
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ronald E Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Kirstin Vach
- Institute for Medical Biometry and Statistics, Center for Medical Biometry and Medical Informatics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ralf-Joachim Kohal
- Department of Prosthetic Dentistry, Center for Dental Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Rabel K, Spies BC, Pieralli S, Vach K, Kohal RJ. The clinical performance of all-ceramic implant-supported single crowns: A systematic review and meta-analysis. Clin Oral Implants Res 2019; 29 Suppl 18:196-223. [PMID: 30306684 DOI: 10.1111/clr.13337] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/30/2018] [Accepted: 06/05/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This review aimed at evaluating the survival and technical complication rates of all-ceramic implant-supported single crowns (SC). MATERIAL AND METHODS Three electronic databases were searched for clinical studies conducted at ≥ 15 patients examining implant-supported all-ceramic SCs over ≥ 12 months. Survival rates of implants and restorations plus technical complication rates of SCs were calculated and tested for statistical correlation with confounding variables. Statistical analysis was performed using a negative binomial distribution model to calculate 5- and 10-year survival and complication estimates. RESULTS Forty-one included studies reported on implant-supported SCs made of veneered and monolithic high-strength oxide ceramics, monolithic, and veneered glass-based ceramics and of a monolithic resin-nano-ceramic (RNC). Survival estimates for SCs of 93% (95% CI: 86.6%-96.4%) after 5 years and 94.4% (95% CI: 91.1%-96.5%) after 10 years were calculated, corresponding values for implant survival were 95.3% (95% CI: 90.6%-97.7%) and 96.2% (95% CI: 95.1%-97.1%). Technical complication rates after 5/10 years were as follows: chipping 9.0% (95% CI: 5.4%-14.8%)/2.7% (95% CI: 2.1%-3.5%), framework fractures 1.9% (95% CI: 0.7%-4.9%)/1.2% (95% CI: 1%-1.5%), screw loosening 3.6% (95% CI: 1.6%-8.4%)/5.2% (95% CI: 3.6%-7.5%), and decementations with 1.1% (95% CI: 0.4%-2.8%) after 5 years. Some confounding variables influenced the above-mentioned estimates significantly. CONCLUSIONS All-ceramic implant-supported SCs showed-with the exception of a RNC material-high survival rates. However, failures and technical complications occurred which have to be considered when informing patients on the treatment with implant-supported all-ceramic SCs.
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Affiliation(s)
- Kerstin Rabel
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Benedikt Christopher Spies
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Campus Benjamin Franklin (CBF), CC 3 Dental and Craniofacial Sciences, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Stefano Pieralli
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Campus Benjamin Franklin (CBF), CC 3 Dental and Craniofacial Sciences, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kirstin Vach
- Institute of Medical Biometry and Statistics, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Ralf-Joachim Kohal
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center - University of Freiburg, Freiburg, Germany
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30
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Lifetime prediction of veneered versus monolithic lithium disilicate crowns loaded on marginal ridges. Dent Mater 2019; 35:511-522. [DOI: 10.1016/j.dental.2019.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/02/2018] [Accepted: 01/11/2019] [Indexed: 11/19/2022]
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Lemos CAA, Verri FR, Gomes JMDL, de Souza Batista VE, Cruz RS, Oliveira HFFE, Pellizzer EP. Ceramic versus metal-ceramic implant-supported prostheses: A systematic review and meta-analysis. J Prosthet Dent 2019; 121:879-886.e4. [PMID: 30661882 DOI: 10.1016/j.prosdent.2018.09.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 11/16/2022]
Abstract
STATEMENT OF PROBLEM There is insufficient evidence to recommend the restorative material for implant-supported prostheses. PURPOSE The purpose of this systematic review and meta-analysis was to evaluate studies that compared ceramic and metal-ceramic restorations for implant-supported prostheses (within the same study to avoid indirect comparison) in terms of the mechanical and biological complication rates, prosthesis survival rate, and marginal bone loss. MATERIAL AND METHODS Two independent reviewers performed a comprehensive search in databases (PubMed/MEDLINE, Web of Science, and Cochrane Library) for articles indexed until March 31, 2018. The search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and methods were registered in the International Prospective Register of Systematic Reviews (PROSPERO). The focused question was "Do ceramic restorations have mechanical/biological complication rates, prosthesis survival rates, and marginal bone loss similar to those of metal-ceramic restorations?" RESULTS The search identified 949 references. The interinvestigator agreement using kappa values was 0.87 for PubMed/MEDLINE, 0.93 for Scopus, and 1.0 for the Cochrane Library. After analysis, 12 studies were selected for qualitative and quantitative analysis. The mechanical complication rate did not differ between ceramic and metal-ceramic restorations (P=.89), independent of the type of prostheses (single crown: P=.63; fixed partial denture: P=.65). The biological complication rate was also not significantly different between ceramic and metal-ceramic restorations (P=.21). The prosthesis survival rate showed no significant differences between the 2 types of restorations (P=.56). Marginal bone loss was also similar for both types of restorations (P=.12). CONCLUSIONS This systematic review indicated that ceramic and metal-ceramic implant-supported prostheses have similar mechanical and biological complication rates, prosthesis survival rates, and marginal bone loss. Thus, both treatments are appropriate options for long-term rehabilitation treatment.
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Affiliation(s)
- Cleidiel Aparecido Araújo Lemos
- Postgraduate student, Department of Dental Materials and Prosthodontics, Sao Paulo State University (UNESP), Araçatuba, Brazil.
| | - Fellippo Ramos Verri
- Adjunct Professor, Department of Dental Materials and Prosthodontics, Sao Paulo State University (UNESP), Araçatuba, Brazil
| | - Jéssica Marcela de Luna Gomes
- Postgraduate student, Department of Dental Materials and Prosthodontics, Sao Paulo State University (UNESP), Araçatuba, Brazil
| | - Victor Eduardo de Souza Batista
- Associate Professor, Department of Prosthodontics, Presidente Prudente Dental School, University of Western São Paulo (UNOESTE), Presidente Prudente, Brazil
| | - Ronaldo Silva Cruz
- Postgraduate student, Department of Dental Materials and Prosthodontics, Sao Paulo State University (UNESP), Araçatuba, Brazil
| | | | - Eduardo Piza Pellizzer
- Professor, Department of Dental Materials and Prosthodontics, Sao Paulo State University (UNESP), Araçatuba, Brazil
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ArRejaie AS, Al-Hamdan RS, Basunbul GI, Abduljabbar T, Al-Aali KA, Labban N. Clinical performance of one-piece zirconia dental implants: A systematic review. JOURNAL OF INVESTIGATIVE AND CLINICAL DENTISTRY 2018; 10:e12384. [PMID: 30588750 DOI: 10.1111/jicd.12384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 09/28/2018] [Indexed: 01/11/2023]
Abstract
The aim of the present review was to evaluate the clinical and radiographic performance of one-piece zirconia implants (O-PZI). This review followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines that addressed the following focused question: What is the overall clinical and radiographic performance of O-PZI? The MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register databases were searched. Six clinical studies were included. For studies evaluating O-PZI compared with one-piece titanium implants, zirconia implants showed higher crestal bone loss (CBL) in both the studies. However, one study demonstrated a high failure rate compared to titanium dental implants, while one study demonstrated comparable survival rates between zirconia and titanium dental implants. For studies evaluating O-PZI for the restoration of single crown and fixed dental prostheses, O-PZI showed comparable bone loss and survival rates for single crowns and fixed dental prostheses. Two studies were included that compared O-PZI with two-piece zirconia (T-PZI). One study showed a higher CBL and low survival rate for O-PZI compared to T-PZI, whereas the other study demonstrated comparable CBL and survival rates between O-PZI and T-PZI. It is still debatable whether O-PZI demonstrate better clinical performance when compared with titanium implants or two-piece design.
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Affiliation(s)
- Aws S ArRejaie
- Department of Prosthetic Dental Science, King Saud University, Riyadh, Saudi Arabia
| | - Rana S Al-Hamdan
- Department of Restorative Dental Science, King Saud University, Riyadh, Saudi Arabia
| | - Ghadeer I Basunbul
- Department of Oral and Maxillofacial Rehabilitation, Faculty of Dentistry, King Abdul Aziz University, Jeddah, Saudi Arabia
| | - Tariq Abduljabbar
- Department of Prosthetic Dental Science, King Saud University, Riyadh, Saudi Arabia
| | - Khulud A Al-Aali
- Department of Prosthodontics, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Nawaf Labban
- Department of Prosthetic Dental Science, King Saud University, Riyadh, Saudi Arabia
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Degidi M, Nardi D, Sighinolfi G, Degidi D, Piattelli A. The Conometric Concept: A Two-Year Follow-Up of Fixed Partial CEREC Restorations Supported By Cone-In-Cone Abutments. J Prosthodont 2018; 28:e780-e787. [PMID: 30295374 DOI: 10.1111/jopr.12962] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2018] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate the performance of definitive, implant-supported, lithium disilicate fixed dental prostheses (LS2 FDPs) manufactured with a computer-assisted design/computer-assisted manufacturing (CAD/CAM) system. All patients received two-unit restorations placed in posterior regions, supported by osseointegrated implants with cone-in-cone connection abutments. MATERIALS AND METHODS Two implants (Ankylos) were placed into healed sites or fresh extraction sockets in the maxillary/mandibular posterior regions of partially edentulous patients. Definitive digital impressions were made 3 months after surgery. Twenty-four patients received fixed monolithic LS2 restorations manufactured with the CEREC system. All restorations were connected to the implants using cone-in-cone connection abutments. Peri-implant pocket depths were recorded for 2 years at each follow-up visit. Esthetic, functional, and biologic United States Public Health Services (USPHS) parameters modified by the FDI World Dental Federation study design were assessed yearly until the last follow-up appointment. The opposing dentitions were identified by type of restoration and supporting structures at the time of placement of the definitive restorations and at the 2-year follow-up visits. RESULTS One patient (4.16%) moved to an unknown location during the study. A total of 23 FDPs (95.8%) supported by 46 implants reached the 2-year follow-up. None of the prostheses failed, or became loose or detached. No significant difference involving probing levels between the experimental times were found. CONCLUSIONS The results of this research indicated that the abutment-prostheses connection using a cone-in-cone approach was successful within the 2-year period of this study. None of the studied monolithic LS2 glass-ceramic prostheses milled using the CEREC CAD/CAM system fractured or became detached.
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Affiliation(s)
| | - Diego Nardi
- Department of Neuromotory and Biomedical Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | | | - Davide Degidi
- Department of Neuromotory and Biomedical Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Adriano Piattelli
- Department of Medical, Oral, and Biomedical Sciences, University of Chieti-Pescara, Chieti and Pescara, Italy
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Teichmann M, Göckler F, Rückbeil M, Weber V, Edelhoff D, Wolfart S. Periodontal outcome and additional clinical quality criteria of lithium-disilicate restorations (Empress 2) after 14 years. Clin Oral Investig 2018; 23:2153-2164. [PMID: 30276515 DOI: 10.1007/s00784-018-2649-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 09/20/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the clinical quality of tooth-supported crowns (SCs), implant-supported crowns (ISCs), and fixed dental prosthesis (FDPs) made of a lithium-disilicate glass-ceramic framework material (IPS Empress 2, Ivoclar Vivadent) after long-term use. MATERIALS AND METHODS Between 1997 and 1999, 184 restorations (106 SCs, 32 ISCs, 33 FDPs, 13 diverse restorations) were placed in 73 patients. In 2012/2013, all patients with functioning restorations were invited to participate in a clinical follow-up examination. To investigate the clinical quality, modified California Dental Association (CDA) criteria, periodontal health, and the patient's opinion were evaluated. RESULTS After 14 years on average, 50 restorations were available for evaluation of the CDA criteria and the patient's opinion, and 24 restorations were available for the periodontal health evaluation. Surface, color, anatomic shape, and margin integrity were considered to be in the range of excellence in 54, 78, 96, and 88%, respectively. There were no unacceptable defects. Most patients (64%) were still entirely satisfied with their restorations. Mean probing depths were significantly higher on teeth with tooth-supported Empress 2 restorations than on control teeth (p = 0.0401). No significant relationship was found between surface quality and plaque accumulation (p = 0.9450, generalized linear mixed model) or between surface quality and periodontal probing ≥ 4 mm (p = 0.4184, generalized linear mixed model). CONCLUSIONS The clinical quality of the Empress 2 restorations that had survived 14 years on average was totally satisfactory with regard to esthetics, design, and patient's opinion. The periodontal health of all-ceramic restored teeth requires further investigation. CLINICAL SIGNIFICANCE The practitioner's choice of dental materials is based, at best, on long-term experience. With diminishing concerns about the clinical longevity of all-ceramic restorations, the grading of clinical quality based on esthetics, design, periodontal response, and patients' opinions could, nowadays, serve as a measure for the efficiency of dental ceramic.
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Affiliation(s)
- Maren Teichmann
- Department of Prosthodontics and Biomaterials, Center of Implantology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Fabian Göckler
- Department of Prosthodontics and Biomaterials, Center of Implantology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Marcia Rückbeil
- Department of Medical Statistics, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Volker Weber
- Dental laboratory Impladent GmbH, Kullenhofstraße 30, 52074, Aachen, Germany
| | - Daniel Edelhoff
- Department of Prosthodontics, School of Dentistry, Ludwig-Maximilians-University, Goethestr. 70, 80336, Munich, Germany
| | - Stefan Wolfart
- Department of Prosthodontics and Biomaterials, Center of Implantology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
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Digital versus Analog Procedures for the Prosthetic Restoration of Single Implants: A Randomized Controlled Trial with 1 Year of Follow-Up. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5325032. [PMID: 30112398 PMCID: PMC6077568 DOI: 10.1155/2018/5325032] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/03/2018] [Indexed: 11/17/2022]
Abstract
Aim To compare the outcome of digital versus analog procedures for the restoration of single implants. Methods Over a two-year period (2014-2016), all patients who had been treated in a dental center with a single implant were randomly assigned to receive either a monolithic zirconia crown, fabricated with digital workflow (test group), or a metal-ceramic crown, fabricated with analog workflow (control group). All patients were followed for 1 year after the delivery of the final crown. The outcomes were success, complications, peri-implant marginal bone loss (PIMBL), patient satisfaction, and time and cost of the treatment. Results 50 patients (22 males, 28 females; mean age 52.6±13.4 years) were randomly assigned to one of the groups (25 per group). Both workflows showed high success (92%) and low complication rate (8%). No significant differences were found in the mean PIMBL between test (0.39±0.29mm) and control (0.54±0.32mm) groups. Patients preferred digital impressions. Taking the impression took half the time in the test group (20±5min) than in the control (50±7min) group. When calculating active working time, workflow in the test group was more time-efficient than in the control group, for provisional (70±15min versus 340±37min) and final crowns (29±9min versus 260±26min). The digital procedure presented lower costs than the analog (€277.3 versus €392.2). Conclusions No significant clinical or radiographic differences were found between digital and analog procedures; however, the digital workflow was preferred by patients; it reduced active treatment time and costs. The present study is registered in the ISRCTN (http://www.isrctn.com/ISRCTN36259164) with number 36259164.
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Spies BC, Witkowski S, Vach K, Kohal RJ. Clinical and patient-reported outcomes of zirconia-based implant fixed dental prostheses: Results of a prospective case series 5 years after implant placement. Clin Oral Implants Res 2017; 29:91-99. [PMID: 28940708 DOI: 10.1111/clr.13072] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate the clinical and patient-reported outcome of all-ceramic zirconia implant supported fixed dental prostheses (FDPs) 5 years after implant installation. MATERIALS AND METHODS Thirteen patients were treated with two terminally placed one-piece zirconia implants for a three-unit FDP each. The FDPs consisted of a CAD/CAM-fabricated zirconia framework over-pressed with a fluor-apatite veneering ceramic and were adhesively cemented. Survival and success were assessed by applying modified US Public Health Service (USPHS) criteria and preparation of Kaplan-Meier (KM) plots. Alpha and Bravo ratings were accepted for success (among others including small area veneer chippings and occlusal roughness), whereas Charlie ratings allowing for intra-oral correction (e.g., polishing) were accepted for survival. Furthermore, patient-reported outcome measures (PROMs) were analyzed with the help of visual analogue scales (VAS). Wilcoxon matched-pairs signed-rank test (USPHS criteria) and linear mixed models (PROMs) were used to evaluate time effects on response variables. RESULTS All patients were available 61.8 ± 1.1 months after implant installation (53.6 ± 3.1 months after final prosthesis insertion). FDP survival was 100%. Significant incidence of veneer chipping (p = .0096) and occlusal roughness (p = .0019) was observed. Charlie rated extent of both phenomena resulted in a KM success estimate of 38.5% (95% CI: 14.1%-62.8%; seven FDPs with obvious roughness, three of them with extended veneer chipping). Compared with the pre-treatment assessments (30%-81% of satisfaction), all surveys at prosthetic delivery showed significantly improved VAS scores (66%-93%; p ≤ .038), except for speech (p = .341). Concerning function, esthetics and self-esteem, no decrease in satisfaction could be observed until the end of follow-up (90%-96%; p ≥ .057), whereas perception of sense (92%) and speech (95%) increased over time (p ≤ .030). Occurrence of technical complications did not correlate with patient satisfaction. CONCLUSIONS Bi-layered FDPs made from zirconia/fluor-apatite highly satisfied patients but showed significant incidence of technical complications.
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Affiliation(s)
- Benedikt Christopher Spies
- Department of Prosthetic Dentistry, Center for Dental Medicine, Medical Center - University of Freiburg, Faculty of Medicine - University of Freiburg, Freiburg, Germany
| | - Siegbert Witkowski
- Department of Prosthetic Dentistry, Center for Dental Medicine, Medical Center - University of Freiburg, Faculty of Medicine - University of Freiburg, Freiburg, Germany
| | - Kirstin Vach
- Center for Medical Biometry and Medical Informatics, Institute for Medical Biometry and Statistics, Medical Center - University of Freiburg, Faculty of Medicine - University of Freiburg, Freiburg, Germany
| | - Ralf-Joachim Kohal
- Department of Prosthetic Dentistry, Center for Dental Medicine, Medical Center - University of Freiburg, Faculty of Medicine - University of Freiburg, Freiburg, Germany
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